Introduction: Paralysis generally indicates an inability to move one or more joints of the body voluntarily. This may follow Head Injury, Stroke, Brain surgery, Major Injury, Nerve-related disease, or Nerve damage.
Some of the names associated with the condition of paralysis include Brachial plexus injury, Motorcycle accident, Inability to move the shoulder, Inability to move the elbow, Loss of movement of a part of the body/finger, Nerve injury, Wrist drop, Inability to move the hand, Inability to move the fingers, or Inability to move the thumb.
Surgery can help alleviate numerous paralytic conditions and improve the quality of life. The surgery may involve nerve repair, nerve grafting, nerve transfer or tendon transfer, or some type of joint surgery.
*Brachial Plexus.
Commonly, a young man driving a motorcycle falls with the impact on the side of the neck. This causes injury to one or more of the five nerves which provide sensation and power to the upper extremity. If these patient do not show recovery in a couple of month, they will require surgery, the surgery involves microscopic techniques of nerve repair, nerve grafting, nerve transfer or neurotization.
Microsurgery requires a delicate repair of the nerve under microscope.
The picture shows a very fine needle being used for nerve repair.
*Obstetric Paralysis.
The child was born after a difficult labor. The parents noticed that the child is not able to move the shoulder and the elbow. Baby was unable to elevate her shoulder and unable to reach out to objects due to paralysis of certain muscles of the shoulder. The child was 5 years old at the time of first presentation.
A technique of tendon transfer was utilized to re-activate and lift up the shoulder (Abduction) in the sky and reach out as well (External rotation). If the child presents early and at the age of 3 months if the child is unable to flex the elbow, one must offer nerve surgery. In late presentation like here, consider tendon transfer.
*Volkmann's Ischemic Contracture.
The child sustained a fracture of his elbow, the plaster was applied. Later he developed certain contractures called as Volkmann’s Ischemic Contracture or VIC.
He was unable to flex his fingers and had no sensation in the fingers. The first surgery was in the form of neurolysis of the median nerve and the ulnar nerve. He made remarkable recovery of the sensation. In the absence of any recovery of the finger flexion, second surgery was undertaken. A tendon was mobilized from the back of the wrist and used to provide power to the finger flexors (ECRL to FDP).
Before Surgery
After Surgery
*Paralysis due to a Lump.
The patient presented with progressive weakness of finger, clumsiness of finger movements and inability to extend the fingers.
She was investigated and was found to have a lump in the elbow region, compressing the radial nerve. The lump was removed protecting the nerve. In due course, she had full recovery.
Lump being extracted from under the nerve
